Exploring the Impact of Neonatal Transport on the Health of Black Preterm Infants and Psychosocial Challenges Faced by Parents in Relation to Social Determinants of Socioeconomic and Racial Inequities
Abstract
Neonatal transport is a unique aspect of preterm birth. This descriptive, exploratory dissertation study used a multiple-case study design, and mixed methods approach to describe the trajectory of Black preterm outborn infants and their mothers from birth, through transport to a referral center through NICU hospitalization until discharge, for a detailed analysis of each case. The specific aims were 1) Describe each infant's transport trajectory, including baseline characteristics of the community hospital of birth (size, level of care, birthing resources), transport characteristics (mode, distance, personnel), and infant health from birth to arrival of regional referral neonatal intensive care unit; 2) Describe each infant's longitudinal clinical course trajectory including significant morbidity from admission to the NICU until discharge; 3) Examine and describe the barriers and psychosocial challenges faced by parents due to transport and NICU hospitalization of their infant in relationship to social determinants of socioeconomic and racial inequities. We used the Electronic medical records (EMR) to describe the transport trajectory, and publicly available information to describe the birth hospital. We longitudinally examined psychological distress in the mother (measured through anxiety, stress, and depression surveys) and the health of the infant over the NICU course trajectory (using EMR data). Surveys assessed socioeconomic status, infant access and bonding barriers, and bias and discrimination. Interviews to address relevant constructs of the integrated theoretical framework provided a comprehensive understanding of mothers' perceptions of preterm delivery, transport, and NICU experiences. These case studies resulted in rich, in-depth, multi-faceted data to elucidate this under-researched phenomenon. Results indicated that psychological stress in parents was higher when measured at the second event than after the initial unexpected preterm birth when their infant was transported. Although six of the seven participants did not indicate bias or discrimination through surveys, interviews revealed multiple instances where these Black women were dismissed or discounted, which may reveal aspects of structural discrimination. This study highlights the importance of equitable, comprehensive care during this highly stressful time for mothers. It emphasizes the need for future research on Black mothers' experiences with preterm labor, specifically in the context of neonatal transport and structural discrimination.